Name: V N Nuvaira Tasneem

Matric No.: A185408

Date: 5/7/2024

2. How is your progress?

This week was very exciting and meaningful as I managed to gain a lot of new experiences this week such as scrubbing into OT and presenting cases during ward rounds. 

I managed to clerk patients before attending ward rounds and also present my findings. One of the patients I clerked for was a 70 year old Malay lady who came into hospital due to right hypochondriac pain. I took her history in Malay and also did a quick physical examination on her. It was quite nerve-wracking at first to be presenting my case in front of the entire team. After my case presentation, the consultant enquired the patient about any recent travel history in English which the patient could not understand. I stepped in by translating to the patient in Malay and translated back her answer to the consultant. Overall, my case presentation went well and my supervisor encouraged me by saying that I did a good job. This experience taught me the importance of being able to speak and understand basic conversational Malay as it came in helpful during the ward round. It also taught me the importance of giving your best in whatever task you’re assigned to and learning as much as you can from the opportunity given.

I also got the chance to attend more OT sessions this week and even had the opportunity to scrub in and assist my supervisor during the surgery. One of the OT sessions which I enjoyed the most was the total parathyroidectomy in which I assisted my supervisor to take pictures whenever needed. Even though I had to stand for long hours, it was still very exciting to be able to see how the surgeons worked as a team to remove the 4 parathyroid glands. Each gland was a small yellow pea-sized tissue which the surgeons had to remove. It was more like a treasure hunt which was quite enjoyable to watch. I also managed to scrub in for the total thyroidectomy with deltoid implantation procedure. It was my first time scrubbing into OT however I managed to get some help from the kind scrub nurse who reminded me of the protocol of scrubbing into OT. I was asked to hold the retractor in place and also assist my supervisor to cut her sutures once she finished suturing. I found these tasks very interesting as it was my first time being so close to the patient and also to the operating table. I enjoyed being their surgery assistant which further deepened my interest in Surgery. 

I also got the chance to attend the morning Morbidity & Mortality meeting in which the General Surgery Department reviewed past cases to discuss what went wrong and how to improve for the future. I found this meeting very interesting as it showed me that even as surgeons, reflection is very important as it provides a platform for growth. I also managed to attend the inaugural opening of the National University Centre for Trauma at NUH which was very fun. 

3. Points to remember from week 2!

• Be courageous to try new things

• Learn from your mistakes

4. Your feelings & thoughts 

Overall, this week was very meaningful and I’m very glad that I took the courage to present my case during the ward round even though it was my very first time doing it. I’m also very happy that I managed to scrub into OT and assist the surgeons, which I never had the chance to do. It was truly an eye-opening and memorable experience.

5. ONE good thing from what you did that you can practice now!

One good thing I did was to take the courage to try new things even though it was my first time. 

Even though I did not feel very confident presenting my case and scrubbing into OT, I still did it and I realized that it’s important to take the first step because that’s the only way in which I can learn from my mistakes and grow.

6. Any difficulties/concerns? How did you cope?

This week was slightly challenging as I had to do new things but one way I coped was to prepare myself adequately. Before presenting my case during ward round, I first made sure I made it early to the ward so that I had ample time to clerk the patient and consolidate my findings before ward round started. I also watched videos and read up on how to scrub into OT before I got the chance to scrub in which made it much easier when I was actually doing it in the scrub room. Hence, I learnt that though trying new things is good, it is even better when I prepare myself fully for the new challenge I am going to face.

7. Your plan for next week (Week 3)

• To gain more hands-on experiences at the OT 

• To clerk more patients with interesting findings

Matrics Number: A188948

Date: 15 July 2024

2. How is your progress?

After the trip to Saidia, I went to clinical clerkship as scheduled. To be honest it was a bit hard for me to get into the mood for clinical clerkship due to all the fun I had last weekend at Saidia hahaha, but life goes on anyways. I've been getting more and more familiar with the hospital and the residents, doctors and professors in the Traumatology Department. I could even hold conversations with the nurses in the department (even though we can hardly understand each other due to the language barrier but we try our best!). I even got to observe a surgery involving an open fracture of the proximal tibia (Intramedullary nailing of the tibia). Throughout the surgery, my fellow Moroccan friend (a 6th year medical student) explained to me as much as she could and I am really really grateful for that. Unfortunately, I only managed to observe one surgery throughout the whole week which reason will be written below.

For the rest of the week in the hospital, I observed bandage changing, wound cleaning and plaster casting. I even got the chance to change the dressing with the supervision of one of the residents. During our free time, the medical students, doctors and residents will come over and chat with me, and I would use this opportunity to learn some local Arab / French phrases that could be useful such as "I want to eat = Bikhit nakkhul (I try my best to write down the pronunciation ahhaha), I want to sleep = Bikhit nenas, Hello how are you = Salam labas" etc. In the meantime they would ask me how to say words in Chinese and Malay as well, which I am proud to teach ~ It was really a fun and interesting experience there.

As for time outside of clerkship, the local committees as usual held a number of social programs for us. First is hiking, where I got to witness the beautiful view of Oujda City beneath and also the nature terrains of Morocco rocky mountains. Second would be the National Food and Drinks Party (NFDP) where all the incoming students as well as the local committees will prepare dishes from their own country for everyone to taste. I made Nasi Goreng Ayam, which I am glad that many praised to be "like its from a Asian Restaurant" (I am the ONLY Asian in the whole group) AHHAAHHA. Plus I also wore my Baju Kurung to the party to introduce our traditional costume to the others, really proud to be able to spread something from my country to the others and seeing them enjoy it. I also got to taste a huge variety of Moroccan food as well as food from Hungary, Czech Republic, Greece, Tunisia, and Jordan, truly a wonderful experience. After eating, we all sat down to enjoy local Moroccan music played by a band which members consist of the local committees, speak about the amount of dedication and effort put into this program. With all these social programs and interacting with other exchange students (not to mention getting to eat Nasi Goreng Ayam as well haha), the slight homesick I felt from last week eased a lot, and I am truly glad about this.

There are also programs held in the weekends where we get to go on a trip to the famous Blue City --- Chefchaouen. But it is getting too much in this post so I will keep this trip for the report next week.

3. Points to remember from week 2!

• The healthcare workers throughout the whole Morocco are on a big open-ended strike, so they only accept emergency surgeries, no appointment for surgeries are made and the main operation theatre is closed until the strike ends.

• For fractures, the best and lowest risk of infection treatment is the orthopedics approach (plaster casting), but if the fracture is complicated, surgical approach is indicated with intramedullary nailing being the surgical procedure with low risk of infection.

• The professors, doctors as well as residents love students to ask a lot of questions, no matter how absurd the questions are, they are really happy to be able to explain and solve the question together. And this is a very positive thing that I observed throughout my clinical clerkship. Professors treat medical students as their colleague and after the consultation of every patient, the professor will use some time before the next patient comes in to explain the patients conditions and raise discussion to the medical students in the consultation room.

• A very random fact: the "fake" Oreos (as in Oreo alternatives) sold in Morocco has VERY little cream in it (shown in the picture that I've uploaded HAHHA)

4. Your feelings & thoughts

• Dilemma: As far as I sympathize with the healthcare workers for wanting a better working environment and treatment from the government, I can't help but to feel sad for the patients that really needed help. The strike that is going on really affected the quality of treatment being offered by the hospital. During the consultation, the professor mentioned to me that he felt frustrated with the strike that is going on because there are a lot of patients that needed surgical appointments to undergo knee joint replacement surgeries and they can't do it due to the strike. I really felt sad and torn between two parties in this situation.

• Grateful: I am really grateful towards the committees for arranging social programs for us.

• Loved: Throughout this week I've expressed my homesickness to the new friends I've made through this program, and they were really really nice to me about it. They do their very best to console me and made me felt at home. They are really a great group of people with wonderful personalities. I also got to call back home a few times, constant reassurance from my parents made me feel calmer too.

5. ONE good thing from what you did that you can practice now!

Ever since I noticed how the professors and doctors here love students to ask questions, I became daring to ask even the most absurd questions that I wouldn't in a million years ask the doctors in UKM. And the professors and doctors did their very best to explain it to be and I learned a lot from asking. I will definitely try my best to ask more questions during classes back in Malaysia.

6. Any difficulties/concerns? How did you cope?

To my surprise this week has been great! Mainly the homesickness that I've been feeling which I cope by talking to my friends and family about, and that really really helps! As for the language barrier, I am starting to get use to it, the doctors are really nice to translate everything in English for me. To be honest I just wish that I can learn a language in 3 days (which is impossible) but how convenient it is to be able to do that hahaha. Starting to appreciate how I am able to communicate with patients in Malaysia with our Malay, English and Chinese language.

7. Your plan for next week (Week 3)

• Observe at least one more surgery

• Plan a trip to Tangier with 3 other exchange students!

• Visit the Oujda Medina at least once to buy souvenirs.

Koay Hong Xin, A189444, 15 July 2024.

2. How is your progress?

Elective posting started with orientation around the campus by PIC from the International Affairs Office. I was briefed and brought to familiarise myself with the cardiology department of SAHZU, China. Subsequently, I had the opportunity to follow ward rounds every morning and attend clinics together with my doctor. She was so nice and kind that she explained and taught me about the diseases of every patient, including the interpretation of ECG as well. Furthermore, I followed the other doctor to another campus where I had the chance to observe and learn about different heart-related procedures such as percutaneous coronary intervention, radio-frequency ablation, stent placement in the coronary arteries, etc.

3. Points to remember from week 2!

Cardiovascular diseases are very common in China and ECG interpretation is very important in diagnosing and getting a picture of what is going on with the patient.

4. Your feelings & thoughts.

Making the decision to conduct my elective in SAHZU is one of the best decisions that I have made in my journey as a medical student. Doctors here are so nice that they constantly guide and ask about how I feel in the department. They do not hesitate to teach and give a thorough and complete explanation as long as you ask. Furthermore, they always bring me for lunch and buy me beverages almost every day. I truly have a great time gaining fantastic exposure to cardiology in SAHZU!

5. ONE good thing from what you did that you can practice now!

Soft skills that I developed and improved here in SAHZU are indeed a helpful component that I can practice now as a medical student. By being alone in the department, I had to push myself to keep taking the initiative to ask and communicate with different doctors here on my own to seek various hands-on opportunities. All these indeed further improved my soft skills, and I realised that sometimes what we need is an environment to push us on further improving in real life. I am now more confident in communicating and taking the initiative to ask for opportunities and I believe that this will be helpful in my journey as a medical student in UKM as well!

6. Any difficulties/concerns? How did you cope?

Initially, I had some difficulties understanding medical jargon in Mandarin as our syllabus in Malaysia is taught in English. However, things get better by utilizing the features of Google Translate and the doctors here are always willing to translate the words into English whenever I couldn’t understand certain medical jargon. Subsequently, I feel more comfortable and am familiarised with their way of communication.

7. Your plan for next week. (Week 3)

Mingle with other doctors in the department and look for opportunities to follow them in dealing with patients and getting involved in more bedside clinical activities.

Name: Lai Kam Hoong

Matric number: A189642

Date: 15 July 2024

2. How is your progress?

Week 2 was a productive week for me as I had many new opportunities and experiences in the hospital.

As there is a new patient with pancreatic carcinoma was admitted to the ward for surgery, I followed a senior medical student to clerk the patient and perform a physical examination. The senior medical student explained the patient's condition to me and taught me how to write a complete patient history.

On Tuesday, I joined a multidisciplinary team meeting of the pancreatic division at the PUMCH Consultation Center for Complex Diseases. The healthcare professionals gathered to discuss complex pancreatic cases and their subsequent management. To my surprise, the meeting included not only healthcare providers but also the patients and their family members. The professors and doctors discussed the cases, provided input, and tailored the management plans. They then called upon the patient and family to explain and answer their questions on the spot. It was such an effective and efficient for all the parties.

On Wednesday, a group of students from another university visited the department, and I joined them. I had the chance to visit the hospital's surgical skill lab, which is very modern and equipped with laparoscopic and robotic simulators for practice. The doctor explained laparoscopic techniques using a simulator to us, and I got to try it myself. Additionally, I was exposed to the robotic simulator and was taught on how to control it.

I assisted in one thyroid surgery this week and observed a 3D laparoscopic thyroidectomy. Unlike conventional open thyroidectomy, an incision was made in the axilla region instead of the anterior neck region, and the procedure was visualized in 3D. It was my first time wearing 3D glasses to observe a surgical procedure, which was captivating and fascinating. I learned that this procedure is very safe and provides better cosmetic results for the patient. The 3D visualization in the surgery not only provides real-time depth estimation but also allows for precise incisions by the surgeon. I also observed a Whipple operation using the Da Vinci robotic surgery system for a patient with pancreatic carcinoma.

3. Point to remember from week 2 !

• A multidisciplinary approach is essential for managing complex diseases, as it could provide tailored management plans that lead to better patient outcomes.

• Practice is the key to mastering surgical skills. Becoming proficient in surgery requires consistent repetition and hands-on experience.

• Incorporating advanced technology in surgery enhances precision, reduces operating time, and leads to better health outcomes, including less pain and shorter recovery periods.

4. Your feelings & thoughts

I was amazed and impressed by how the professors and doctors conducted the multidisciplinary meeting for patients with complex diseases. The meetings are attended by healthcare professionals from various disciplines, including surgeons, internal medicine specialists, radiologists, oncologists, pathologists, and nurses. What stood out to me was the inclusion of the patient and their family members in the discussion.

During the meeting, the doctors first discuss the case among themselves. Then, they will invite the patient and their family members into the meeting room to explain the proposed plan and answer all their questions. I find this approach very compassionate. The two-way communication makes the patient feel more secure and helps build a strong rapport with the doctors. In the meeting, I could sense that the patient received the support they needed and their well-being was being prioritized.

5. ONE good thing from what you did that you can practice now!

One good thing that I did was stepping up to volunteer for opportunities. PUMCH offers many opportunities for hands-on experiences. By taking initiative, I could make the most of every learning opportunity that comes my way.

6. Any difficulties/concerns? How did you cope?

One difficulty I faced this week was my lack of basic surgical skills. I had the opportunity to assist in an open thyroidectomy, and during the surgery, the surgeon placed a drainage tube at the surgical site. He then asked if I wanted to try tying the knot for the tube. I was shocked at that time because I had never tied a surgical knot on a real patient before. I felt lack of confidence and had not practiced this skill beforehand.

However, the surgeon kept encouraging me to give it a try and he even handed me the suture. In the end, I was not able to tie the knot properly and he tied the knot anyways. I felt disappointed in myself for not having practiced this skill earlier even though I had learned it in a workshop before. After this, I started watching videos online and practiced knot-tying to ensure I'm better prepared for future opportunities.

7. Your plan for next week (Week 3)

• Brush up on my surgical skills, such as tying surgical knots.

• Revise anatomy to gain a better understanding during the surgery

NAME: SERENA SEET SU YUIN

MATRIC NUMBER: A189015

Date: 11/8/2024

2. WHAT HAVE YOU DONE?

   • My very first week begun with an orientation and mask fitting in the tower block of NUHS. I was briefed upon several items. One most remarkable thing that was briefed upon was regarding cybersecurity and how stringent NUHS is with patient’s data protection and governance. Later on, the students’ access cards were distributed and we, overseas elective students, were brought around the hospital for a short building orientation.

   • On the very first day, I begun my week by attaching to a Houseman in the HPB team which brought me to wards. I was given an opportunity to assist in a Peripherally Inserted Catheter (PICC) removal. I then was given an opportunity to watch 2 surgeries back-to-back. The first surgery was an appendectomy which was complicated by an iatrogenic perforation. The second surgery was a pilonidal abscess Incision and Drainage. I was also given the opportunity to join the exit rounds to which the doctor I attached to had to go for a second ward round to make sure all his patients are stable for the night.

   • On the second day, I joined the team for a routine morning ward wound. After the ward rounds, I was given the opportunity to observe an open abdominal surgery of a periampullary tumour removal and a laparoscopic cholecystectomy. I also took history and did physical examination on a jaundiced patient.

   •The third day was indeed a productive day for me. I was able to follow up on the patient who had the periampullary tumour resection. I am humbled to learn the patient’s post-operation progress in real-time and felt a sense of gratitude that I was able to learn the patient’s recovery journey. I then joined the private clinic of my supervisor. I was then given an opportunity to join the night shift on-call team. During the night shift on-call, I assisted my doctor in a wound cleaning of a major MVA patient that was brought into the Emergency Room at night. Unfortunately, due to the chaos, I was not able to get a picture of myself cleaning the wound.

   • The fourth day brings me back to my routine morning ward rounds. I was also able to follow up with the periampullary tumour resection patient. I then joined my supervisor for the subsidised clinic. I was then able to learn the differences between the private and subsidised clinics. I was then given the chance to observe 2 laparoscopic cholecystectomies one of which is an acute cholecystitis patient.

   • The fifth day falls on the National Day of Singapore. I took the opportunity to visit the Universal Studios of Singapore.

   • On the sixth and seven day, I did some rock climbings with my family and visited the Supertree Grove!

3. Points to remember from week 1:

   • The private clinic in NUHS contains more public relation compared to the subsidiary clinics of HPB.

   • Many documents of patients are digitalised. Cybersecurity is a major component in healthcare here!

   • All patient’s appointments are digitalised!

   • Healthcare workers here prefer to use the stairs than the elevators! Good shoes are important!

4. Your feelings and thoughts:

   • I feel utterly grateful to be assigned to the team of doctors who give me loads of opportunity to learn. I was indeed very grateful to be able to learn from every patient’s history and disease progression.

   • The first day did catch me off guard when I first learn that doctors here are very physically inclined. They have a tendency to run up and down the stairs. They also prefer sports shoes over formal shoes for easy mobility.

   • I was very grateful that I get to experience my first night shift alongside with the NUS medical students who were very friendly to me. This marks my very first time of having an emergency MVA patient in my care. Serves as a preparation and an eye opener for the ED posting in year 4

   perhaps?

5. Any difficulties/ concerns? How did you cope?

   • As healthcare workers here are very mobile, I had my first difficulty in running about the hospital with formal shoes. A doctor advised me to use sports shoes instead! That definitely eased my walking and running in the hosptial .

   
   

6. 2 words to describe elective posting progress so far:

   • Productive

   • Exciting

7. Plan for next week (week 2):

   • Morning ward rounds

   • Clinic sessions and the usual routines!

Name: WONG JIAN CONG

Matric Number: A188021

Date: 5th August 2024

2)What have you done?

On the 5th of August 2024, mark the beginning of my elective posting under the hepatobiliary and pancreatic surgery department at National University Hospital (NUH), in which on the day itself, other students from a variety of countries along with me had a brief orientation from Miss Mazzie, who is the coordinator, and together with that, I had also undergone a mask fitting session, which was supervised by Mr. Clerence, who was in charge of the fitting session.

After the brief orientation, I was given a tag and a starter kit, which is composed of a little journal book and pens that allow me to take note of things that I will learn within the two weeks. In addition to that, I was given a tour by none other than Miss Mazzie, who showed us around the hospital, which includes the operation theater and the ward.

Once I had completed the tour, I contacted my supervisor, Dr. Gao Yu Jia, who is a consultant of the Hepatobiliary and Pancreatic Surgery Department, where I was given the opportunity to meet not only him but his team, such as Associate Professor Glenn Kunnath Bonney and Associate Professor Shridhar Iyer, who is a senior consultant of the Hepatobiliary and Pancreatic Surgery Department, and also other residents who were in the team as well.

At that time, I had the pleasure to join the pre-op meeting among the hepatobiliary and pancreatic surgery team, where I got to watch the resident discuss the surgery that would be performed for that entire week. After that, I was attached to Prof. Shridhar Iyer at his clinic, where I learned there were different approaches in terms of consulting patients with different diagnoses. Throughout the clinic session, I was taught about Hepatocellular Carcinoma and types of genetic testing that was offered to patient.

Not only that, throughout the week I had the opportunity to join Dr. Gao Yujia in a laparoscopic cholecystectomy procedure where I was given a green light to actually dissect apart the gallbladder that had been removed from the patient. Besides that, Dr. Gao was guiding me along the surgery by explaining the approach to the laparoscopic cholecystectomy procedure, where I learned about the importance of the Chalot Triangle.

On Thursday 8th of August 2024, I had the pleasure to join Prof. Glenn for a Whipple procedure where I was given the permission to stand on the standing stool right behind Prof. Glenn for the next 6 hours of surgery, where I was able to witness Prof. Glenn's skills and the technique that Prof. Glenn for a Whipple procedure where I was given the permission to stand on the standing stool right behind Prof. Glenn for the next 6 hours of surgery, where I was able to witness Prof. Glenn's skills and the technique that Prof used during the surgery, and throughout the surgery, Prof. Glenn exposed me to the approach to this procedure as it is a complicated procedure that involves the dissection of the head of the pancreas, bile duct, gallbladder, and part of the small intestine.

Other than that, I had joined the ward round every single morning starting at 8 a.m., in which I visited patients that were assigned to the hepatobiliary and pancreatic surgery department, in which I was attached to Dr. Sarah, who was responsible for the ward round itself.

3) Points to remember from Week 1

a) I would say I had learnt the importance of adding prognostic factor when it come to consulting patients as it allow the Dr to determine the best form of treatment for different patient in term of overall well-being.

b) I also learnt the importance of communication skills in which I was one of the observer that witness my supervisor had to break the bad news to a patient that had a stage 3 cancer in which my supervisor shown signs of empathy and He had taken the time to support the patient and ensuring the patient to not give up as there is always hope.

c) I also learnt that working as a team plays a role in my supervisor team as I was told that working together with different consultant improve the overall treatment of a patient because during ward round, instead of one consultant deciding on the follow-up for the patients, my supervisor actually discussed the cases with different consultants to get their opinions.

4) Your feelings and Thought

Overall, I felt excited that I was able to learn a lot during my first week, and I noticed that Singapore takes patient confidentiality to a very high security level, as I was not able to assess the patient information even though I was a temporary student. I think Singapore did a good job in ensuring patient information is well protected and to prevent any data leak.

More than that, I realized everything in Singapore is fast-paced because, from the moment I started my first day, I noticed everyone does not waste any second of their time.

5) Any difficulties and concern? how did you cope?

One difficulty that came across me was the way around in NUH, as I realized that the hospital itself was big and divided into different zones, which left me confused every time I was getting to different places. However, I am able to get my way around as there were staff within the hospital, which I was able to ask for direction from, and they were willing to help.

6) Two words to describe elective posting progress so far

1) Excitement

2) Adrenaline rush

7) Your plan for next week?

I was hoping to join more OT sessions and get more hands-on experience, and I was planning to get attached to one of the residents for the rest of the day to watch the daily life of a resident working under the hepatobiliary and pancreatic surgery team.

Woong Jia Hui

A190103

14 August 2024

2. How is your progress?

This week (29 July to 2 August) marks the first week of my attachment to the Paediatrics Haematology-Oncology Department in KK Women’s and Children’s Hospital Singapore. My assigned supervisor is Dr. Soh Shui Yen, a senior consultant and the head of the department.

On the first day (29 July), I was given a tour around the hospital by Ms. Aishah from the KKH Education Office. After that, I met my supervisor, Dr. Soh for the first time and she gave me a briefing about their department schedule for the month of August. I was required to follow morning ward rounds with the team from Ward 75 every day for my first week. I also joined Dr. Soh’s outpatient clinic after the ward round until 12:30 p.m. I managed to meet many patients who were battling with childhood cancer as her clinic focused more on Oncology. I ended my first day with the Haem-Onc Monday Academic Afternoon which they were discussing about the topic of Bone Health in Childhood Cancer Survivors. 

On my second day (30 July), I started my day with the morning ward round and joined my supervisor’s clinic until 5:00 p.m. I was more familiar with the patients in Ward 75 and their conditions as compared to my first day. I also made friends with the house officer, Dr. Bryan Wong, and he was nice enough to give me some pointers when I don’t understand what are the senior doctors discussing about. The consultants also asked me questions and gave me some teaching while moving in between beds.

On my third day (31 July), I joined the Oncology Weekly Grand Round after my morning ward round until 12:30 p.m. All the consultants, specialists, registrars, MOs, HOs and senior staff nurses were present to discuss about all the cases in both Ward 75 and 76. After lunch, I visited the Children’s Day Therapy (CDT) to observe some procedures done on the patients in my ward.

On my fourth day (1 August), I joined Dr. Lee Ming Wei’s clinic which focused more on Haematology patients. I learnt more about thalassaemia, iron-defiency anaemia, and ALL. 

On my fifth day (2 August), I observed a bone marrow aspiration procedure done on a 1 year 11 month old male patient with AML with left eye chloroma after the morning ward round. I ended my first week joining Dr. Lee Ming Wei’s clinic again.

3. Points to remember from week 2!

• Neuroblastoma is not a tumour that affects the CNS. It is a malignant neuroendocrine tumor of the sympathetic nervous system that originates from neural crest cells. It is one of the most commonly seen solid tumours in children after brain tumours. Neuroblastoma can appear as a posterior mediastinal mass on chest X-ray.

• Doxorubicin can cause cardiotoxicity. It is important to monitor the cardiac biomarkers and imaging in patients undergoing chemotherapy with doxorubicin. Cardioprotective medicine should be prescribed for those patients.

• Tumour lysis syndrome, febrile neutropaenia, and hyperleukocytosis are oncological emergencies in children.

• The housemanship programme in Singapore only lasts for 1 year. Every HO will have to rotate through 3 departments (internal medicine, general surgery, OBGYN/Paediatrics) for a duration of 4 months each.

• Only Singaporean PR/citizens can apply for their residency programme to become a specialist here. It will take Malaysian doctors at least a few more years compared to their Singaporean counterparts to become a specialist in Singapore.

4. Your feelings & thoughts 

I feel grateful that the doctors are willing to teach me despite their busy schedule. This week was a great introduction to Paediatrics for me and it sparked my interest to study harder. I am glad that I stepped out of my comfort zone and took the initiative to communicate with the doctors around me as I obtained more information about the working environment here and career advancement opportunities.

5. ONE good thing from what you did that you can practice now!

I am more confident in approaching Haematological and Oncological cases in Paediatric patients after observing how the doctors in KKH handle cases in the ward and outpatient clinic.

6. Any difficulties/concerns? How did you cope?

I could not catch up with all the ward round cases as I did not have a account to access their patient information database (Citrix). I did not have any physical files to read as all the patient information is digitalised. I had to listen carefully to what the doctors were discussing in front of every bed during the ward round and jot down notes to make sure I am on the same page with the doctors. I also asked the HO’s help to show me the patient’s case notes on his laptop whenever he is free.

7. Your plan for next week (Week 3)

• Study, study, study

• Network with more doctors and my supervisor 

• Rest well and recharge by spending quality time with friends during the weekend

• Try more Singaporean food and see how different it is from Malaysian food

STAY TUNED FOR WEEK 2 YAH GUYSSS

Name: Seenivasan Aparrna

Matric No.: A185410

Date: 3rd August 2024

2. How is your progress?

This week was an enthralling week with many first hand experiences! Throughout the week, I attended ward rounds, attached to clinics as well as went to the Operating Theatres (OTs).

During the ward rounds, I got the opportunity to visit the children in the Pediatric Intensive Care Unit (PICU), High dependency wards as well as the Neonatal ICU. I was able to witness first hand the various diseases that plague children as well as learn about the management plan catered to each child. At the end of the ward rounds, the Medical Officers (MOs) conducted Q&A sessions, where they will test me on my basic surgical knowledge. During these sessions, they highlighted some facts that had to be especially taken note of in the pediatric population. Thanks to these sessions, I was able to supplement as well as refresh my existing knowledge.

During the clinic attachments, I was able to observe the discussion that my supervisor had with the families of the patients. Most patients had come for follow up after surgeries such as frenectomy, hernia repair as well as circumcision. I learnt about the aspects we have to look into while taking the history and conducting physical examination post operatively. At times, there were new cases. During these consultations, I learnt the differences there are in the approach to history taking as well as conducting physical examination in the pediatric population, as the differentials varied drastically from adults. Furthermore, I was able to appreciate my supervisor’s communication style to build a rapport with the children, to gain their consent to examine them, and the parents to gain their trust.

The OT sessions were a completely different experience. The surgeons were very generous in letting me scrub in and assist with every pediatric surgery that took place that week! This was my first time assisting with surgeries and I was thrilled. I was able to closely observe the surgeries, equipment and techniques used, as well as learn the rationale behind each step of the surgery. Some surgeries that I participated in were US guided femoral Peripherally Inserted Central Catheter (PICC) insertion and fluoroscopy of abdomen, circumcision, herniotomy and exploratory laparotomy for pneumoperitoneum.

Overall, the first week was very fruitful.

3. Points to remember from Phase 2!

Be bold, do not hesitate to try something new, as the fear of failing will not bring you places.

Always keep revising, keep abreast with basic medical knowledge.

4. Your feelings & thoughts

Initially I was disturbed by the condition of the patients as it was disheartening to see children suffering from illnesses when they could be enjoying their childhood. I could not imagine the pain they and their parents must have been in. This gave me a different perspective on life.

However, at the same time, the strength of the parents in such situations was empowering. They had an unshakable faith in the doctors and were patiently waiting for a beam of hope. Their emotional resilience was remarkable.

I also understood the immense responsibilities that the doctors have in shaping the child’s future and the importance of patience, compassion and maturity when treating children.

5. ONE good thing from what you did that you can practice now!

I never gave up on the effort to learn. I read up on whatever I had learnt whenever I had the time, such as during my break times in the hospital, early in the morning before ward rounds and even during the train rides! I even woke up as early as 4am to prepare for the day ahead.

6. Any difficulties/concerns? How did you cope?

Initially, there was some difficulty in keeping up with the discussions during ward rounds as I did not have access to the electronic medical records of patients and thus had no idea on the diagnosis of the patient. Therefore, I felt lost during discussions on the management plan. Thereafter, before the ward rounds every day, I would clarify the cases to be discussed on that day and their diagnoses with the MOs. I would quickly read up on them before the ward rounds. This allowed me to get a better sense of the things being discussed during ward rounds.

7. Your plan for next week (EP Week 2)

I would like to prepare myself better by revising on my basic surgical and anatomical knowledge, as well as improve my knowledge on common pediatric disease conditions so that I am able to make the most out of the ward rounds, clinics and OTs.

Secondly, I plan to learn different suturing techniques in practice, especially in pediatrics.

Name: Yong Zong Sheng

Matric Number: A185595

Date: 10/8/24

2. How is your progress?

During the first day in the KTPH, Ms Evelyne, the education development officer gave me a briefing and brought me around the hospital. After that, she handed me over to the sister in the major OT to teach me the proper procedures of washing hands, donning and doffing personal protective equipment and reminded me about the protocol of the operation theatre. Then, I met with my supervisor, Dr Anil, a senior consultant of general surgery. He told me to follow the houseman, Dr Wei Yang to go around the wards that were in charge under him. All of a sudden, he received a call from the nurse, and he quickly brought me to that ward. The ECG of the patient showed tachycardia and the absence of p-waves. He suspected that the patient was having atrial fibrillation. After the case, the time already reached 5 pm, I went back home but Dr Wei Yang still stayed at the hospital to proceed with his tasks.

The following day, after the wad round, I followed Dr Kang to the operation theatre. She was going to perform laparoscopic cholecystectomy. Then she gave me a chance to become her assistance. I would share more details in question 4.

At the end of the week, I got the opportunity to observe some operations that I never observed before in HUKM such as perforated appendicitis, perforated acute cholecystitis and colectomy. Meanwhile, I also took the opportunity to form a bond with the houseman there when I was free. After I had a deep conversation with them, I could feel that the barrier between me and them slightly disappeared. The great thing about new friends was that they brought new energy to my soul. One of the purposes of this elective posting was to form an international bond with the doctors or medical students in Singapore.

In a nutshell, I was still adapting to the new environment. It was my time to step out of my comfort zone and begin to change, grow and transform. I hoped that I could become a more resilient person after the elective posting.

3. Points to remember from week 2!

• Stop being afraid of what could go wrong and start being excited about what could go right.

• Next to the new environment, adjust according to the situation then overcome the challenges.

• Life is unpredictable and you never know what is coming next. Don’t ever get too comfortable, always be ready for the challenges.

4. Your feelings & thoughts

The tiring part was because I had to take the bus for at least 1 hour to the hospital in the morning and 1-hour bus back to the house in the afternoon. Therefore, in total, I had to spend around 2 hours per day travelling to the hospital and back to the house. Moreover, when I back home I had to force myself to study the cases that I had met that day, especially for the management part. During the morning ward round, the residency normally would ask me a few questions regarding the management of certain diseases such as management of acute cholecystitis, appendicitis and so on but I enjoyed revising that knowledge. The reason for doing so was because I did not want to embarrass my university, UKM.

The enjoyable part was the learning processes and the opportunities to assist Dr Kang in the laparoscopic cholecystectomy. I was quite surprised that Dr Kang asked me to wear the full PPE, and she required my help to hold the gallbladder of the patient during the operation. At that time, I was blank and nervous. I was scared that I could not fulfil the task given by Dr Kang. I was also scared that I might make some silly mistakes that might affect the smoothness of the operation. During that moment I had not much time to consider whether I wanted to assist or not because if I rejected this opportunity, I might not have the chance anymore. Without further hesitation, I nodded my head and quickly put on the PPE as soon as possible. During the operation, I held the gallbladder with the instrument and observed on the screen to see how they did the operation. Suddenly, Dr Kang asked me about the Calot’s Triangle of the gallbladder, honestly speaking I was blank and forced my brain to recall the anatomy of the gallbladder. Unfortunately, I only managed to answer 2 borders of the triangle. After that, they asked me about the layer of the abdomen. I could only answer the questions incompletely. At that moment, I felt that I had embarrassed my university. I felt guilty for not being able to recall what I had learned before. The operation lasted for 3 hours and I also paid full attention to the operation as well. It was my honour to be involved in the surgery. When they did time out, they also mentioned my name. I could not express how excited was I during that moment. I felt that I was part of the team. Even though I was a medical student, they still provided a precious chance for me. This incident increased my eagerness to become a surgeon in the future.

5. ONE good thing from what you did that you can practice now!

Self-directed learning was very important. As an overseas medical student in Singapore, no one would spoon-feed me and tell me what I should do. I had to list out my objectives and try to fulfil them every day otherwise I would just waste my time walking around the hospital. Therefore, I always asked myself what I wanted to observe in the hospital and what I was interested in. With this self-discipline, I listed a few things that I had to do every day. Normally after the ward round, I would find the interesting cases to clerk and then I would read back the management for the cases that I had met during the ward round. After that, I would go to the major and minor OT to check the operation today. I would check if were there any operations under my supervisor or any cases that I was interested in. Then I would follow the schedule to go to the respective operation theatre to observe the procedures. If I still had time, I would go to the staff lounge to prepare the cases. I also would make the effort to approach the seniors there to build rapport with them. As the Chinese saying goes, “At home one relies on his parents, while away from home one relies on his friends.” In conclusion, self-directed learning not only involves becoming aware of and managing one's process of learning, but it also includes developing dispositions that support motivation, self-regulation, perseverance, adaptability, and resilience.

6. Any difficulties/concerns? How did you cope?

It was very hard for me to search for a suitable case to clerk. This was because KTPH did not have a specific surgery ward, and the patients would be placed according to the classes of their medical insurance. Therefore, I have to go around the wards one by one. To overcome this problem, I would ask the houseman in my team to give me extra copies of the list of patients that our team was in charge of. Normally they would print out the list of patients with the details to bring it over to the morning meeting before the ward round started. Hence, I requested help from them to give me a copy of it. In this situation, I could know the process and diagnosis of the patient. It helped me to save time and helped me to achieve my tasks. Sometimes, I would also ask the nurses in the ward to know the cases in the ward. Through this, I was able to find the case and not like going around the ward to look at the patient face one by one. I also saved the phone number of the medical officer and houseman so that they could contact me if they have met with any new cases. In my team, they all were very friendly and helpful. I appreciate their help.

Another difficulty raised along with this was I did not have access to the patients’ details due to the confidentiality of the personal data. I did not have a temporary account to access the details before or after I had clerked a case. In UKM, normally I would look at the chief complaint of the patients first before I approach them. In KTPH, I could do so. Hence, it was very difficult for me to identify the cases of the patients. Even if I got to clerk the patients, I could not check back whether the details that I clerked were sufficient or not and I could not confirm the diagnosis of the patients. For example, I have clerked a patient with rectal bleeding, my provisional diagnoses were diverticular bleeding and colorectal carcinoma, but I could not confirm whether was I correct or not. To overcome the problem that I mentioned, I would approach the nurses in the wards and borrow their accounts to get access to the patient information. Sometimes I would get rejected but most of the time I could manage to find a nurse to help me. Before this, I also tried to approach the medical students in KTPH but unfortunately, they also have limitations in accessing the details. Therefore, they could not lend me their account.

7. Your plan for next week (Week 3)

• I plan to observe some mastectomy cases in the following week. I have never observed it before in UKM. I hope that I can get the opportunity to observe it.

• I also want to clerk some trauma cases. I hope that I manage to observe them to handle the trauma cases in the emergency ward.

• I hope I can have a chance to have a meal with the UKM’s seniors in KTPH (Dr Shasi and Dr Ying Hui). I want to understand more about the working environment and life as a houseman in Singapore. I hope to get closer and stay connected with them

• Last but not least, I want to observe colonoscopy and OGDS in the following week.

 Lee Jun Jie

A187968

05.08.2024

2. How is your progress?

On the first day of my posting, I arrived at Tower E of KTPH hospital to meet Ms. Evelyn, the coordinator for my elective. She briefed me on the hospital's rules and regulations and welcomed me with a KTPH notebook, pen, and some masks as a gesture of hospitality. Afterward, she gave me a tour of the hospital, during which I discovered that KTPH has a staff lounge equipped with table tennis, snooker, and even a small medical library. What surprised me the most was that KTPH is also equipped with a bomb shelter! I also contacted my assigned supervisor, Dr. Kang Min Li, from the Emergency Surgery Acute Trauma (ESAT) department. After the orientation, Dr. Kang took me to observe a laparoscopic umbilical hernia procedure in the OT rooms.

On the second day, I attended a morning meeting at 7:30 a.m. at the Cardiovascular Center's learning center, where the team discussed patient details and management strategies. Afterward, I accompanied my supervisor on ward rounds. I noticed that the patients’ beds were not categorized into General Surgery or Internal Medicine, but were scattered throughout. Once the ward round concluded, the team took a morning break at the nearby canteen to have coffee and discuss the day's duties. My supervisor kindly offered me a hot Milo. After that, I had the opportunity to clerk some patients.

On the third day, I continued attending the morning meeting and ward rounds. During the break, I presented a case to my supervisor, who provided valuable feedback on my presentation skills. Later, I resumed clerking patients. In the afternoon, my supervisor brought me to observe an adhesiolysis for a small bowel obstruction in the OT. It was an incredible experience, as I watched them remove the dilated small bowel and the adhesions causing the obstruction—my first time witnessing such a procedure.

By the fourth day, I had settled into the routine of attending morning meetings and ward rounds. During the break, I presented my cases to my supervisor again. Suddenly, she received an emergency activation call from her department, and I followed her to the emergency department. There, I witnessed the efficiency of the emergency team firsthand. The patient arrived within 10 minutes, and in the same amount of time, the team had assessed the patient’s vital signs and injuries. They quickly performed an X-ray using a portable machine and soon after, sent the patient for a CT scan. Their swift trauma management prevented the patient from developing more severe conditions, such as a pneumothorax, despite rib fractures. I was truly impressed by their speed and efficiency.

On the fifth day, which coincided with Singapore's National Day, I had a holiday. I spent the day exploring Singapore with friends and enjoying the local cuisine.

3. Points to remember from week 2!

·        Before entering and leaving the operating theatre, we are required to fill out and submit OT forms each time for evacuation purposes in the event of a fire.

·        The doctors at KTPH hospital prefer to be addressed by their first names rather than their titles, which fosters a friendly and approachable working environment in the healthcare sector.

·        The Emergency Surgery Acute Trauma (ESAT) department does not hold clinic sessions but must remain on standby at all times to handle emergencies.

4. Your feelings & thoughts

I am excited to explore the healthcare system in Singapore for the first time, especially since it is more modern than in Malaysia. However, I also felt anxious when I couldn't answer some questions from the doctors at KTPH hospital. This was due to not having reviewed anatomy since my clinical years. Despite this, I am grateful to have met my supervisor and her team, who were incredibly friendly and patient in teaching me.

5. ONE good thing from what you did that you can practice now!

I plan to regularly revise my basics, particularly the knowledge I gained during my preclinical years.

6. Any difficulties/concerns? How did you cope?

It takes me about 1 hour and 30 minutes to reach KTPH by MRT and bus, which means I have to sleep and wake up early to arrive at the hospital before 7:30 a.m. I feel that this commute time is somewhat wasted, considering the journey would only take around 20 minutes by car.

7. Your plan for next week (Week 3)

I need to contact my next assigned supervisor, Dr. Marc Ong Weijie, from the Breast/Endocrine department. I'll be revising my theory to ensure I’m better prepared to answer any questions my supervisors may ask.

Name: Bhelvinder Singh A/L Surinder Singh

Matric Number: A190104

Date: 11/8/2024

2. What have you done?

• The week started with an orientation by the staff at NUH. The orientation comprised of a short briefing on rules and reminders, distribution of access cards, mask fit testing session and a tour of the hospital. After the orientation, I contacted my supervisor, Dr. Nivedh and he introduced me to his colleagues in the neurosurgical team.

• I shadowed my supervisor in the specialists’ clinic and the orthopaedics clinic. While I was in the clinic, he asked me questions regarding the symptoms that patients presented with and their underlying conditions. Whenever I asked a question, he would always answer it and explain it thoroughly. If he couldn’t make it to the clinic, he would ask me to shadow his registrar, Dr. Tingting instead.

• In addition, I had the opportunity join ward rounds at wards 25 and 52 where I witnessed the doctors using the Glasgow Coma Scale (GCS) to evaluate patients’ level of consciousness.

• I also got the opportunity to join journal club which is a 1 hour online session held weekly. During journal club, an academic article which a doctor finds interesting is presented to their colleagues. The findings of the article are then discussed by the doctors.

• Furthermore, I was asked to join the weekly multidisciplinary team meeting and morbidity and mortality meeting where I was able to witness the collaborative effort of doctors from various specialties as they discussed regarding the management and outcomes of patients under their care.

• In conjunction with Singapore’s 59^th National Day on 9/8/2024, I took the opportunity to visit Marina Bay Sands and Merlion Park where I was able to watch magnificent fireworks at night. I also visited the various attractions at the nearby Sentosa Island which included Siloso Beach and Fort Siloso.

3. Points to remember from phase 2!

• Many patients who presented to the clinic were elderly patients and more often than not, they would have two complaints which are back pain and leg pain, usually find their leg pain to be more distressing since it affects their mobility

• Patients which required to undergo surgery had to be informed of that option in a calm, collected manner. They also had to be informed of the risks from the surgery. The doctor must then listen attentively and address any concerns the patient might have in addition to providing reassurance.

4. Your feelings & thoughts

• I am grateful to be assigned to a kind and understanding supervisor. His approach during clinic sessions to ask me questions and to clarify my doubts whenever I ask him a question made me feel that I was actively participating in the clinic.

• This has encouraged me to step out of my comfort zone and be more proactive. My supervisor and his registrar also treat me to the delicious food and drinks during our breaks.

• Other than that, I am grateful for the smooth journey throughout this first week of clinical electives in NUH so far which makes me looking forward to next week.

P.S. In my humble opinion, Malaysian nasi lemak is undoubtedly better than Singaporean nasi lemak.

5. Any difficulties/concerns? How did you cope?

• I planned to travel daily from the hostel to NUH by MRT. However, I was unfamiliar with the route and interchanges that I needed to take. Hence, I studied the MRT map which can be accessed online and asked the friendly staff at the MRT station for some help. I also tried to take the MRT route to NUH on the day before reporting there. By being familiar with the MRT route in advance, I can ensure that I have a smooth journey to NUH and that I will be able to arrive there on time.

6. 2 words to describe elective posting progress so far

• Exhilarating

• Inspiring

7. Your plan for next phase (Phase 3)

• Visit operating theatre to observe surgeries

• Attend surgical conference

• Explore other tourist hotspots